Study of patterns of medical care utilization using computer algorithms

Li, Nan (2000) Study of patterns of medical care utilization using computer algorithms. Masters thesis, Memorial University of Newfoundland.

[English] PDF (Migrated (PDF/A Conversion) from original format: (application/pdf)) - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. Download (4MB) [English] PDF - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. (Original Version)

Abstract

The main purpose of this study is to investigate and characterize patterns of medical care utilization, specifically, to discover if there are associations between patterns of medical care utilization and demographic variables, socioeconomic status, and area of residence for three diagnostic groups (cardiovascular disease, mental disease and chronic respiratory conditions) across three geographical categories which divide the island into three areas by degree of urbanization. This study focuses on ambulatory physician visits which included outpatient, emergency room, and office visits, and excludes physician visits to hospitalized patients and visits to nursing home residents. It uses secondary data generated by the Newfoundland Panel on Health and Medical Care (NPHMC). The NPHMC began with a cross-sectional telephone survey in 1994-95 (random single-stage cluster sample of households selected by RDD); respondents who gave written consent to access medical care databases became the utilization panel. This panel was then linked to utilization databases - hospital separations and physicians' claims - using the provincial health insurance number, for a seven-year period (April 1, 1992 - March 31, 1999). The analysis in this thesis includes 678 subjects for cardiovascular disease, 402 subjects for mental disease, and 942 subjects for chronic respiratory conditions, 20 years or older, residing in the province of Newfoundland, Canada, and followed for four years (April 1, 1992-March 31,1996). -- Patterns of utilization in the three diagnostic groups were investigated by dividing the four-year study period into 16 trimesters and using SAS programs to identify five main patterns of care: non-episodic, isolated episodes, and continuous episodes over 2-5, 6-11, or 12-16 consecutive trimesters. Respondents were assigned to one of three classifications by urbanization level: metropolitan St. John's, other urban, and remote, which acted as a proxy for level of medical care resources. -- The hypothesis that demographic and socioeconomic variables, and geographical categories were associated with patterns of medical care utilization was tested separately for hospitalizations and physicians' visits. Residents in metropolitan St. John's are more likely to have continuous episodes than those in other urban or remote areas no matter what diagnosis they have. Residents in remote areas are more likely to be hospitalized than those in urban areas. The respondents who are older and have lower socioeconomic scores are more likely to have continuous episodes of GP visits for the three diagnoses. Generally, respondents with any of the three diagnoses are more likely to be older, have poorer health and lower socioeconomic scores, and live in urban areas as compared to those without the three diagnoses. -- Descriptive and multivariate analyses clarify the complex association with demographic and socioeconomic variables, as well as with the urban variable. It appears from the analysis that even in a society with universal medical coverage there is an increase in continuous episodes for specialist visits in the urban areas of the three diagnostic groups, and an increase in the continuous episodes for GP visits in the urban areas for all subjects. The subjects in the remote areas have a higher probability of being hospitalized for the three diagnostic groups. As expected, access has significant influence on patterns of specialist visits. This study provides some evidence to increase knowledge of the factors which determine patterns of medical care utilization for the three diagnostic groups.

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